- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,137.96 / $15,848.93
| Facility | | $1,621.81 | $2,137.96 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $912.01 / $2,238.72
| Professional | | $741.31 | $912.01 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $851.14
| Facility | | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,479.11 / $2,238.72
| Professional | | $851.14 | $1,479.11 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,584.89 / $1,949.84
| Professional | | $1,202.26 | $1,584.89 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,258.93 / $1,995.26
| Facility | | $812.83 | $1,258.93 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,445.44 / $2,089.30
| Professional | | $1,230.27 | $1,445.44 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,548.82 / $1,659.59
| Facility | | $1,288.25 | $1,548.82 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,230.27 / $1,737.80
| Facility | | $831.76 | $1,230.27 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $1,513.56 / $2,187.76
| Professional | | $79.43 | $1,513.56 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44,668.36 / $63,095.73 / $89,125.09
| Facility | | $44,668.36 | $63,095.73 | $89,125.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,659.59 / $2,398.83
| Professional | | $1,445.44 | $1,659.59 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $26,302.68 / $75,857.76
| Facility | | $3,311.31 | $26,302.68 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,548.82 / $2,187.76
| Professional | | $1,047.13 | $1,548.82 | $2,187.76 |